Local Heat Applications as a Treatment of Physical and Functional Parameters in Acute and Chronic Musculoskeletal Disorders or Pain.

OBJECTIVES: The aim of this systematic review and meta-analysis was to evaluate the effectiveness of local heat applications (LHAs) in individuals with acute or chronic musculoskeletal disorders. DATA SOURCES: An electronic search was conducted on MEDLINE, Cochrane Controlled Register of Trials, Current Nursing and Allied Health Literature, and the Physiotherapy Evidence databases up to December 2019. STUDY SELECTION: Studies incorporating adults with any kind of musculoskeletal issues treated by LHA compared with any treatment other than heat were included. DATA EXTRACTION: Two authors independently performed the methodological quality assessment using the Cochrane Risk of Bias tool. DATA SYNTHESIS: LHA showed beneficial immediate effects to reduce pain vs no treatment (P<.001), standard therapy (P=.020), pharmacologic therapy (P<.001), and placebo/sham (P=.044). Physical function was restored after LHA compared with no treatment (P=.025) and standard therapy (P=.006), whereas disability improved directly after LHA compared with pharmacologic therapy (P=.003) and placebo/sham (P<.028). Quality of life was improved directly after LHA treatment compared with exercise therapy (P<.021). Range of motion increased and stiffness decreased after LHA treatment compared with pharmacologic therapy (P=.009, P<.001) and placebo/sham (P<.001, P=.023). The immediate superior effects of LHA on muscular strength could be observed compared with no treatment (P<.001), cold (P<.001), and placebo/sham (P=.023). CONCLUSIONS: Individuals with acute musculoskeletal disorders might benefit from using LHA as an adjunct therapy. However, the studies included in this meta-analysis demonstrated a high heterogeneity and mostly an unclear risk of bias.

Physical Management of Scar Tissue: A Systematic Review and Meta-Analysis.

Objective: The aim of this systematic review with meta-analysis was to describe the status on the effects of physical scar treatments on pain, pigmentation, pliability, pruritus, scar thickening, and surface area. Design: Systematic review and meta-analysis. Subjects: Adults with any kind of scar tissue. Interventions: Physical scar management versus control or no scar management. Outcome measures: Pain, pigmentation, pliability, pruritus, surface area, scar thickness. Results: The overall results revealed that physical scar management is beneficial compared with the control treatment regarding the management of pain (p = 0.012), pruritus (p < 0.001), pigmentation (p = 0.010), pliability (p < 0.001), surface area (p < 0.001), and thickness (p = 0.022) of scar tissue in adults. The observed risk of bias was high for blinding of participants and personnel (47%) and low for other bias (100%). Conclusions: Physical scar management demonstrates moderate-to-strong effects on improvement of scar issues as related to signs and symptoms. These results show the importance of specific physical management of scar tissue.

Does the Application of Tecar Therapy Affect Temperature and Perfusion of Skin and Muscle Microcirculation? A Pilot Feasibility Study on Healthy Subjects.

Background: Tecar therapy (TT) is an endogenous thermotherapy used to generate warming up of superficial and deep tissues. TT capability to affect the blood flow is commonly considered to be the primary mechanism to promote tissue healing processes. Despite some preliminary evidence about its clinical efficacy, knowledge on the physiologic responses induced by TT is lacking. Objective: The aim of this quantitative randomized pilot study was to determinate if TT, delivered in two modes (resistive and capacitive), affects the perfusion of the skin microcirculation (PSMC) and intramuscular blood flow (IMBF). Design: A randomized controlled pilot feasibility study. Subjects: Ten healthy volunteers (n = 4 females, n = 6 males; mean age 35.9 ± 10.7 years) from a university population were recruited and completed the study. Intervention: All subjects received three different TT applications (resistive, capacitive, and placebo) for a period of 8 min. Outcome measures: PSMC, IMBF, and the skin temperature (ST) were measured pre- and post-TT application using power Doppler sonography, laser speckle contrast imaging (LSCI), and infrared thermography. Results: Compared with placebo application, statistically significant differences in PSMC resulted after both the resistive (p = 0.0001) and the capacitive (p = 0.0001) TT applications, while only the resistive modality compared with the placebo was capable to induce a significant change of IMBF (p = 0.013) and ST (p = 0.0001). Conclusions: The use of power Doppler sonography and LSCI enabled us to evaluate differences in PSMC and IMBF induced by TT application.

Effects of low-level laser therapy on pain in patients with musculoskeletal disorders: a systematic review and meta-analysis.

INTRODUCTION: This meta-analysis investigated the effectiveness of low-level laser therapy (LLLT) on pain in adult patients with musculoskeletal disorders. EVIDENCE ACQUISITION: A systematic literature search was conducted in the Medline and PEDro databases. Two researchers independently screened titles and abstracts of the retrieved studies for eligibility. Quality assessment of the eligible studies was conducted using the PEDro rating scale. Studies that scored ≥4 were included. A random-effects model was used for this meta-analysis. Subgroup meta-analyses were conducted to evaluate the influence of the adherence of the applied LLLT to the World Association of Laser Therapy (WALT) guidelines, the anatomical site under investigation and the study design on the overall weighted mean effect size. Meta regression was used to assess the possible influence of the study quality on the individual study effect sizes. EVIDENCE SYNTHESIS: Eighteen studies allowing for 21 head-to-head comparisons (totaling N.=1462 participants) were included. The pooled raw mean difference (D) in pain between LLLT and the control groups was -0.85 (95% CI: -1.22 to -0.48). There was high (I²=85.6%) and significant between study heterogeneity (Cochran's Q =139.2; df=20; P<0.001). The subgroup meta-analysis of the comparisons not following the WALT guidelines revealed a D=-0.68 (95% CI: -1.09 to -0.27). In this group, heterogeneity decreased to I²=72.6% (Q=51.2; df=14; P<0.001). In the WALT subgroup D equaled -1.52 (95% CI: -2.34 to -0.70). This between groups difference was clinically relevant although statistically not significant (Q=3.24; df=1; P=0.072). CONCLUSIONS: This meta-analysis presents evidence that LLLT is an effective treatment modality to reduce pain in adult patients with musculoskeletal disorders. Adherence to WALT dosage recommendations seems to enhance treatment effectiveness.

Validity of the twitch interpolation technique for the assessment of quadriceps neuromuscular asymmetries.

This study examined the validity of the twitch interpolation technique for evaluating side-to-side asymmetries in quadriceps neuromuscular function. Fifty-six subjects with a wide range of asymmetries (19 healthy, 24 with unilateral and 13 with bilateral anterior cruciate ligament reconstruction) took part in the study. Supramaximal electrical paired stimuli were delivered to the quadriceps muscle during and immediately after a maximal voluntary contraction (MVC) of the knee extensors (twitch interpolation technique). MVC torque, voluntary activation and resting doublet-evoked torque were measured separately for the two sides, and percent side-to-side asymmetries were calculated for each parameter. MVC torque asymmetry was plotted against voluntary activation asymmetry and doublet-evoked torque asymmetry, and a multiple regression analysis was also conducted. Significant positive correlations were observed between MVC torque asymmetry and both voluntary activation asymmetry (r=0.40; p=0.002) and doublet-evoked torque asymmetry (r=0.53; p<0.001), and their relative contribution to MVC torque asymmetry was comparable (r=0.64; p<0.001). These results establish the validity of the twitch interpolation technique for the assessment of neuromuscular asymmetries. This methodology could provide useful insights into the contribution of some neural and muscular mechanisms that underlie quadriceps strength deficits.

Rehabilitative ultrasound imaging of the supraspinatus muscle: Intra- and interrater reliability of thickness and cross-sectional area.

OBJECTIVE: To examine intra- and interrater reliability of thickness and cross-sectional area (CSA) measurements of the supraspinatus muscle using rehabilitative ultrasound imaging (RUSI). METHODS: Two physical therapists acquired b-mode images of the supraspinatus muscles in twenty-five healthy subjects. Thickness and CSA were measured. Intra- and interrater reliability were examined. RESULTS: Intrarater reliability for thickness was high, (ICC1.1 0.91) for rater 1 and (ICC1.1 0.92) for rater 2. Intrarater reliability for CSA was also high, (ICC1.1 0.90) for rater 1 and (ICC1.1 0.85) for rater 2. Interrater reliability for the thickness was high, (ICC3.1 0.86). For CSA, interrater reliability was moderate, (ICC3.1 0.70). CONCLUSION: Supraspinatus muscle thickness and CSA can be reliably measured by physical therapists in healthy subjects. These findings confirm that RUSI has an interesting potential for physiotherapy clinical practice, especially to assess morphometric changes in skeletal muscles. Further research is needed in subjects with shoulder disorders.

[Anthropometry of the Swiss junior and elite judo national team - a descriptive study]. / Anthropometrie der schweizerischen Junioren- und Elite-Judonationalmannschaft - eine deskriptive Studie.

OBJECTIVE: To establish the anthropometrical characteristics and the hand grip strength of the Swiss junior and elite judo national team. The measured values were compared with data from the literature. METHODS: 24 members, 19 males (23.01 ± 4.91 years) and five females (19.95 ± 2.02 years), were measured. The following anthropometric measurements were made: body size, body weight, six skinfolds (SFT), two breadths, two circumferences, body fat (tanita scale, Durnin and Womersley method), BMI and determination of somatotypes. In addition, the hand grip strength was measured. The anthropometric measurements were carried out in accordance with ISAK guidelines. The literature search was done electronically using PubMed. RESULTS: The mean somatotype of male judoka was 2,2 ± 0,8 for the endomorphy, 6,0 ± 0,9 for the mesomorphy and 2,0 ± 0,7 for the ectomorphy. The mean somatotype was balanced mesomorph. The mean hand grip strength of male judoka was 47,4 ± 6,7 kg. The mean somatotype of female judoka was 3.7 ± 1.2 for the endomorphy, 4,9 ± 0,7 for the mesomorphy and 1,5 ± 0,3 for the ectomorphy. The mean somatotype was mesomorphic endomorph. The mean hand grip strength of the female judoka was 27,0 ± 3,1 kg. There were anthropometric differences between the Swiss juniors and elite judoka and between the Swiss athletes and the athletes of the reference studies. CONCLUSION: The anthropometric data and the results of the hand grip strength give information, which components Swiss judoka should improve. A judoka who does not match the ideal profile can still be successful with the help of other factors (technical, tactical, mental strength).

Changes of skin characteristics during and after local Parafango therapy as used in physiotherapy.

BACKGROUND/AIMS: In physiotherapy, fango (mud) application is a frequently used heat therapy. The main therapeutic effects are due to the elevated temperature of the different tissues with a significant redistribution of blood towards the heated area. This may influence several cardiovascular parameters. There is only limited information on the effect of fango application on skin characteristics. It was the aim of the present study to evaluate the effects of fango application on skin temperature, perfusion of the microcirculation and skin colour. At the same time, cardiovascular parameters such as heart rate, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded. METHOD: Eighteen healthy subjects (age 23.7+/-3.8 years) entered the study. The skin characteristics and cardiovascular parameters were measured before, during and after a 21-min fango application at 44.5 degrees C. RESULTS: Skin temperature and perfusion of the microcirculation increased significantly during fango application: from 35.5+/-0.4 degrees C to 44.3+/-1.2 degrees C for skin temperature and from 23.2+/-8.8 to 197+/-41 p.u. for the skin microcirculation. These two parameters remained elevated during the fango application and decreased slowly to baseline values within 21 min after fango removal. Skin colour (CIELAB, a(*) parameter) increased from 11.0+/-2.5 to 17.9+/-1.9 when comparing pre- with post-treatment values. At the end of the measuring period, the a(*) parameter did not return to baseline values (15.8+/-2.1). Heart rate increased with 8 bpm during the fango therapy and returned to baseline within 3 min after removal of the fango. SBP and DBP varied slightly during the fango application. They returned to baseline values within 21 min after fango removal. CONCLUSION: The skin parameters indicate a transient temperature effect with an increased perfusion of the microcirculation and a flooding of the superficial capacitance system. The cardiovascular parameters were only slightly influenced and remained in the physiological range. Fango application seems not to be too demanding for the cardiovascular system in healthy subjects.

[Sportphysiotherapy interventions in acute inversion trauma: evidence based?]. / Ist die sportphysiotherapeutische Behandlung akuter Inversionstraumata evidenzbasiert?

INTRODUCTION: Epidemiological data show a high injury incidence of the lateral capsular ankle ligaments. About half of the ankle injuries occur during sporting activities, due to an inversion trauma. Although inversion injuries of the ankle are a common problem in physical therapy, there is a converse variety of treatment strategies and differences in therapy outcome. There still seems to be a lack of evidence-based physical therapy strategies for this problem. The aim of this study was to scrutinize literature for the effectiveness of the physical therapy in patients with ankle sprain. METHODS: Relevant studies were collected by conducting a literature search using the online databases; the selection criteria were randomised trails, clinical trails, review articles, and meta-analyses. CONCLUSION: For the diagnosis there seems to be no correlation between the medical classification of injury severity and the prognosis of recovery or between the severity of the ankle ligament injury and clinical findings. In general, there is no or only marginal evidence for the effectiveness of different physical therapies such as cryotherapy, electrotherapy and ultrasound. There is body of evidence that functional treatment is much more effective than immobilisation. Because there is a wide variety of treatment modalities and because in most studies multiple treatment regimens are used, no conclusions can be drawn concerning the effectiveness of specific treatment.